Effects of peroral endoscopic myotomy on achalasia in geriatric patients

Abstract

Objective To evaluate the safety, feasibility, perioperative and long-term efficacy of peroral endoscopic myotomy (POEM) for achalasia (AC) in geriatric patients. Methods Data of 41 patients aged over 65 diagnosed with achalasia and treated with POEM in Zhongshan Hospital from August 2010 to December 2014 were retrospectively studied. Perioperative complications, preoperative and postoperative Eckardt score and pressure of the lower esophageal sphincter, esophageal reflux and clinical failure were analyzed. Results All 41 patients underwent POEM successfully, with median operation time of 42 min. Median hospitalization was 3 days. Major perioperative adverse events occurred in 4 cases (9.75%), whose hospitalization was longer than 5 days for perioperative adverse events. During median follow-up period of 40 months (interquartile range 24-57 months), median Eckardt score decreased from 8 to 1(P<0.001)and pressure of the lower esophageal sphincter decreased from 23.85 mmHg(1 mmHg=0.133 kPa) to 9.05 mmHg (P=0.005). Clinical reflux occurred in 12 cases (29.27%) and the 5-year success rate of POEM was 87.80% (36/41). Conclusion POEM is a safe and reliable treatment for geriatric AC patients with confirmed short-term and long-term effectiveness. Key words: Esophageal achalasia; Geriatrics; Peroral endoscopic myotomy